Correct!

5. Nonspecific interstitial pneumonitis (NSIP)

 

This case is most suggestive of NSIP. Like IPF, NSIP usually presents with chronic dyspnea and cough. Patients typically present between age 40 and 50. HRCT scan reveals ground-glass abnormality, most commonly bilateral and subpleural in distribution with lower lobe volume loss. Patchy areas of airspace consolidation and reticular abnormalities may be present. Honeycombing and traction bronchiectasis as seen in IPF is rare. However there is a continuum of findings in NSIP, with some cases radiographically indistinguishable from IPF (12).

The surgical lung biopsy in NSIP is characterized by varying degrees of inflammation and fibrosis, with some biopsies showing a predominance of inflammatory changes ("cellular" pattern) and others a predominance of fibrotic reaction ("fibrotic" pattern). UIP has more of a temporal heterogeneous pattern.

Hypersensitivity pneumonitis is unlikely as not only did he not respond to corticosteroids, he was removed from his home environment and any likely inciting factors during his prolonged hospital admission without any improvement in his symptoms.

 

Cryptogenic organizing pneumonia (COP) is also unlikely as this usually presents in an acute to subacute form with HRCT demonstrating a predominance of bilateral, patchy consolidation, most commonly with a subpleural or peribronchial distribution. Unlike this case, it often has an excellent clinical response to corticosteroids with improved survival compared with IPF.

 

While desquamative interstitial pneumonia (DIP) will present in smokers in their 30s and 40s, it usually demonstrates more diffuse ground-glass abnormality on HRCT with a histopathological feature of pigment-laden macrophages. Many cases of DIP resolve with smoking cessation and corticosteroids and the prognosis is generally good.

References

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